Clinical Practice Guideline on Utilizing Low-dose Ketamine Infusions for Treatment Resistant Depression

Abstract

Problem & Purpose: Standardly prescribed medications have increasingly become less effective in mitigating depression. This finding has led practitioners to explore alternative ways to treat refractory depression. Ketamine, a dissociative anesthetic, given as a low-dose infusion has become an efficacious regiment for managing the treatment resistant populations symptomology. Clinicians at an outpatient infusion center observed an increase in infusion related hemodynamic abnormalities due to non-standardized infusion therapies. The development and implementation of an evidence-based clinical practice guideline to standardize the administration of low-dose ketamine infusions aims to help alleviate the identified institutional problem. Methods: An extensive literature review was conducted to evaluate the most current evidence regarding ideal ketamine infusion rates to manage treatment resistant depression. A draft clinical practice guideline was developed with assistance from the institution’s stakeholders. The Appraisal of Guidelines for Research and Evaluation II tool was utilized by the stakeholders to appraise the draft guidelines quality. The finalized guideline was presented to the anesthesia team members and critique via provider feedback questionnaire was elicited. Results: The appraisal tools overall domain rating was an 88.9%, which represented a high-quality practice guideline. Provider feedback questionnaire results showed the developed guideline was accepted by stakeholders and anesthesia staff. Implementation of the new practice guideline was recommended without any changes. Conclusion: The anesthesia team valued the developed guideline which led to its acceptance. However, sustainability will rely on the provider success rates based on the utilization of the guidelines recommended dose range as well as periodically collecting and assessing provider feedback questionnaire data to ascertain the level of continued staff buy-in.